Volume 43, March 2026, 101430Author links open overlay panel, , , , , , , , , Highlights•

Diabetes in pregnancy attenuates the sFlt-1/PlGF ratio among women with preeclampsia.

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The sFlt-1/PlGF ratio shows good diagnostic performance in pregnancies affected by diabetes.

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Pregnancies affected by diabetes may warrant a lower diagnostic threshold for the sFlt-1/PlGF ratio.

AbstractObjectives

This study investigate the angiogenic imbalance of soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) among women with any diabetes in pregnancy and suspected preeclampsia.

Study design

A retrospective study of two cohorts of women with suspected preeclampsia who had sFlt-1/PlGF ratio measured as part of routine clinical care. One cohort was based on a clinician-validated dataset (CV cohort) and the other was based on an ICD-coded dataset (ICD cohort). In each cohort, women were categorised into four groups based on the presence or absence of any diabetes in pregnancy and/or preeclampsia.

Main outcome measures

sFlt-1, PlGF, and the sFlt-1/PlGF ratio were presented as median and interquartile range. Receiver operating characteristic analyses were performed to evaluate the discriminative ability of the sFlt-1/PlGF ratio for the Four-Week Prediction of preeclampsia, and the area under the curve (AUC) was estimated.

Results

A total of 455 and 965 women were included in the two cohorts. In both cohorts, the sFlt-1/PlGF ratio was lower in women with preeclampsia and diabetes compared to women with preeclampsia but without diabetes, however the differences were only statistically significant in the CV cohort. The predictive performance of the sFlt-1/PlGF ratio for preeclampsia among women with diabetes differed with AUC values of 0.88 in the CV cohort and 0.73 in the ICD cohort.

Conclusions

This study demonstrated lower sFlt-1/PlGF ratio in women with diabetes in pregnancy who develop preeclampsia, suggesting a lower diagnostic threshold may be more appropriate in this subgroup of pregnant women.

Keywords

Preeclampsia

Solublefms-like tyrosine kinase-1

Placental growth factor

Gestational diabetes mellitus

Pregestational diabetes mellitus

Diabetes in pregnancy

AbbreviationsGDM

gestational diabetes mellitus

T1DM

type 1 diabetes mellitus

T2DM

type 2 diabetes mellitus

sFlt-1

soluble fms-like tyrosine kinase-1

PlGF

placental growth factor

ICD

International Classification of Diseases

ROC

receiver operating characteristic

OGTT

oral glucose tolerance test

© 2026 The Authors. Published by Elsevier B.V. on behalf of International Society for the Study of Hypertension in Pregnancy.